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Levy B, Teplitsky S, Kalaitzoglou E, Kahler S, Matheny JP, Saltzman AF. "Exogenous" 5 Alpha Reductase Deficiency: A Case Report. Urology 2023; 178:147-150. [PMID: 37178876 DOI: 10.1016/j.urology.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 05/03/2023] [Indexed: 05/15/2023]
Abstract
Testosterone and dihydrotestosterone are significant drivers of male external genital development, and therefore teratogens that alter these hormone profiles have been hypothesized to cause aberrations in development. Here, we present the first case report of genitalia anomalies after prenatal exposure to spironolactone and dutasteride through 8-weeks of gestation. The patient was born with abnormal male external genitalia which was surgically managed. Long-term outcomes such as gender identity, sexual function, hormonal maturation through puberty, and fertility remain unknown. These numerous considerations necessitate multi-disciplinary management with close follow-up to address sexual, psychological, and anatomic concerns.
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Affiliation(s)
- Brittany Levy
- Department of Surgery, University of Kentucky, Lexington, KY
| | - Seth Teplitsky
- Department of Urology & Pediatrics, Division of Pediatric Urology, University of Kentucky, Lexington, KY
| | - Evangelia Kalaitzoglou
- Department of Pediatrics, Division of Endocrinology and Barnstable Brown Diabetes Center, University of Kentucky, Lexington, KY
| | - Stephen Kahler
- Department of Pediatrics, Division of Genetics, University of Kentucky, Lexington, KY
| | - Juliann Paige Matheny
- Department of Pediatrics, Division of Genetics, University of Kentucky, Lexington, KY
| | - Amanda F Saltzman
- Department of Urology & Pediatrics, Division of Pediatric Urology, University of Kentucky, Lexington, KY.
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2
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Najam R, Tomar Y, Singh M. Gitelman's Syndrome in Pregnancy With Adverse Foetal Outcome: A Case Report. Cureus 2023; 15:e34791. [PMID: 36915844 PMCID: PMC10006726 DOI: 10.7759/cureus.34791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2023] [Indexed: 02/11/2023] Open
Abstract
Gitelman's syndrome (GS) is a disorder characterized by hypokalaemia, hypomagnesemia, hypocalciuric and metabolic alkalosis. Despite the fact that it affects women of child-bearing age, only limited information is available regarding its impact on maternal and foetal outcome. We present the case of an un-booked and un-investigated 23-year-old primigravida who presented with chief complaints of vomiting and loose stools. The patient also complained of absent foetal movements in the last 12 hours. Investigations revealed hypokalaemia and hypomagnesemia and ultrasound revealed intra-uterine foetal demise. The patient was symptomatically relieved after electrolyte correction. Scarce reports on Gitelman's syndrome in pregnancy have been documented with the majority of cases showing positive outcomes for the foetus. We hereby present a report of a primigravida with Gitelman's syndrome and foetal loss which is considered uncommon.
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Affiliation(s)
- Rehana Najam
- Obstetrics and Gynaecology, Teerthanker Mahaveer Medical College and Research Center, Moradabad, IND
| | - Yugantika Tomar
- Obstetrics and Gynaecology, Teerthanker Mahaveer Medical College and Research Center, Moradabad, IND
| | - Mrinalini Singh
- Obstetrics and Gynaecology, Teerthanker Mahaveer Medical College and Research Center, Moradabad, IND
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3
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Cao Y, Hu D, Yun P, Huang X, Chen Y, Li F. Gitelman syndrome diagnosed in the first trimester of pregnancy: a case report and literature review. CASE REPORTS IN PERINATAL MEDICINE 2022. [DOI: 10.1515/crpm-2021-0075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Objectives
Gitelman syndrome is a rare salt-losing tubulopathy caused by inactivating mutations in the SLC12A3 gene, which is expressed in the distal convoluted tubule and accounts for 5–10% of renal sodium reabsorption. Atypical symptoms and insidious conditions generally delay diagnosis until childhood or even adulthood. Here, we report the case of a 22-year-old Chinese woman who was admitted to our endocrinology department for severe hypokalemia during pregnancy.
Case presentation
The patient had no specific symptoms but exhibited hypokalemia, metabolic alkalosis, hypomagnesemia, hypocalciuria, hyperreninemia, hyperaldosteronism, and normal blood pressure. Together, these symptoms indicated the clinical diagnosis of Gitelman syndrome, which was confirmed by genetic analysis. Many drugs have limited safety data during early pregnancy, and optimum potassium and magnesium levels are necessary for a successful pregnancy.
Conclusions
Diagnosis and management of Gitelman syndrome are crucial during pregnancy to ensure the safety of the mother and fetus, especially during the first trimester.
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Affiliation(s)
- Yang Cao
- Department of Endocrinology , The Seventh Affiliated Hospital, Sun Yat-sen University , Shenzhen , Guangdong , China
| | - Dan Hu
- Department of Endocrinology , The Seventh Affiliated Hospital, Sun Yat-sen University , Shenzhen , Guangdong , China
| | - Peng Yun
- Department of Endocrinology , The Seventh Affiliated Hospital, Sun Yat-sen University , Shenzhen , Guangdong , China
| | - Xinwei Huang
- Department of Endocrinology , The Seventh Affiliated Hospital, Sun Yat-sen University , Shenzhen , Guangdong , China
| | - Yan Chen
- Department of Endocrinology , The Seventh Affiliated Hospital, Sun Yat-sen University , Shenzhen , Guangdong , China
| | - Fangping Li
- Department of Endocrinology , The Seventh Affiliated Hospital, Sun Yat-sen University , Shenzhen , Guangdong , China
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4
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Sanga V, Rossitto G, Seccia TM, Rossi GP. Management and Outcomes of Primary Aldosteronism in Pregnancy: A Systematic Review. Hypertension 2022; 79:1912-1921. [PMID: 35686552 DOI: 10.1161/hypertensionaha.121.18858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Primary aldosteronism (PA) in pregnancy (PAP) can be a serious condition and is challenging to diagnose. This study was conceived to help in the diagnosis of PAP and provide suggestions on management of PAP based on evidence retrieved using a Population, Intervention, Comparison, and Outcome search strategy. Based on the changes of aldosterone and renin occurring in normal pregnancies, we developed a nomogram that will allow to identify PAP cases. Moreover, we found that published PAP cases fell into 4 main groups differing for management and outcomes: (1) unilateral medically treated, (2) unilateral surgically treated, (3) bilateral medically treated and (4) familial forms. Results showed that complications involved 62.2% of pregnant women with nonfamilial PA and 18.5% of those with familial hyperaldosteronism type I. Adrenalectomy during pregnancy in women with PAP did not improve maternal and fetal outcomes, over medical treatment alone. Moreover, cure of maternal hypertension and mother and baby outcome were better when unilateral PA was discovered and surgically treated before or after pregnancy. Therefore, fertile women with arterial hypertension should be screened for PA before pregnancy and, if necessary, subtyped to identify unilateral forms of PA. This will allow to furnish adequate counseling, a chance for surgical cure and, therefore, for a pregnancy not complicated by aldosterone excess.
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Affiliation(s)
- Viola Sanga
- Internal and Emergency Medicine Unit (V.S., G.R., T.M.S., G.P.R.), Department of Medicine - DIMED, University of Padua, Italy.,PhD Arterial Hypertension and Vascular Biology (V.S.), Department of Medicine - DIMED, University of Padua, Italy
| | - Giacomo Rossitto
- Internal and Emergency Medicine Unit (V.S., G.R., T.M.S., G.P.R.), Department of Medicine - DIMED, University of Padua, Italy.,Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (G.R.)
| | - Teresa Maria Seccia
- Internal and Emergency Medicine Unit (V.S., G.R., T.M.S., G.P.R.), Department of Medicine - DIMED, University of Padua, Italy
| | - Gian Paolo Rossi
- Internal and Emergency Medicine Unit (V.S., G.R., T.M.S., G.P.R.), Department of Medicine - DIMED, University of Padua, Italy
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5
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Lim M, Gannon D. Diagnosis and outpatient management of Gitelman syndrome from the first trimester of pregnancy. BMJ Case Rep 2021; 14:14/5/e241756. [PMID: 33980557 PMCID: PMC8118020 DOI: 10.1136/bcr-2021-241756] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
A 32-year-old woman presented with an incidental finding of hypokalaemia on routine bloods at 9 weeks of a second pregnancy, on a background of lifelong salt craving. Her previous pregnancy was uncomplicated. She had no previous significant medical or family history. Venous blood gases showed a hypokalaemic, normochloraemic metabolic alkalosis. Urinary potassium was elevated. Escalating doses of oral supplementation of potassium, magnesium, sodium and potassium-sparing diuretics were required through the course of pregnancy, in response to regular electrolyte monitoring. These were later weaned and completely stopped post partum. Delivery was uneventful with no maternal or neonatal complications. Genetic testing performed post partum showed heterogenous mutation of SCL12A3 gene.
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Affiliation(s)
- Marie Lim
- Colchester General Hospital, Colchester, UK
| | - David Gannon
- Emergency Admission Unit, Colchester General Hospital, Colchester, UK
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6
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Zhang L, Peng X, Zhao B, Zhu Z, Wang Y, Tian D, Yan Z, Yao L, Liu J, Qiu L, Xing X, Chen L. Clinical and laboratory features of female Gitelman syndrome and the pregnancy outcomes in a Chinese cohort. Nephrology (Carlton) 2020; 25:749-757. [PMID: 32542819 DOI: 10.1111/nep.13743] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 05/12/2020] [Accepted: 06/01/2020] [Indexed: 01/08/2023]
Abstract
AIM Gitelman syndrome (GS) is a rare inherited salt-losing renal tubulopathy. Data on clinical features and the pregnancy outcome for female GS patients in a large cohort are lacking. The study was aimed to explore the phenotype and pregnant issue for female GS patients. METHODS GS cases from the National Rare Diseases Registry System of China (NRSC) were collected, and detailed clinical, laboratory and genetic data were analysed. Articles on pregnancy in GS were also systemically reviewed. RESULTS A total of 101 GS patients were included; among them, 42.6% were female and 79.2% showed hypomagnesaemia. A lower proportion of female patients presented before 18 years of age, with less frequently reported polyuria, higher serum potassium and less urine sodium and chloride excretions. There was no gender difference in the sodium-chloride cotransporter (NCC) dysfunction evaluated by hydrochlorothiazide test. Twelve of the 43 female GS patients delivered after disease symptom onset, and their pregnancies were generally uneventful. As a group, pregnant GS patients had lower potassium levels in the first-trimester (P = .002) requiring higher potassium supplementation. After delivery, serum potassium (P = .02) and magnesium (P = .03) increased significantly. Both caesarean section and vaginal delivery were safe. CONCLUSION Female GS patients may have a less severe phenotype with generally favourable outcomes of pregnancy. Intensive monitoring and increased potassium supplementation are necessary during pregnancy, especially in the first-trimester.
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Affiliation(s)
- Lei Zhang
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaoyan Peng
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Bingbin Zhao
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Zhifeng Zhu
- Department of Endocrinology, Inner Mongolia Medical College Affiliated Hospital, Hohhot, China
| | - Ying Wang
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Dongli Tian
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Zhaoli Yan
- Department of Endocrinology, Inner Mongolia Medical College Affiliated Hospital, Hohhot, China
| | - Li Yao
- Department of Nephrology, The First Hospital of China Medical University, Shenyang, China
| | - Juntao Liu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Ling Qiu
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaoping Xing
- Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Limeng Chen
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
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7
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Kallistratos MS, Pittaras A, Theodoulidis I, Grassos C, Poulimenos LE, Manolis AJ. Adverse Effects of Mineralocorticoid Receptor Antagonist Administration. Curr Pharm Des 2019; 24:5537-5541. [PMID: 30799782 DOI: 10.2174/1381612825666190222144359] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 02/13/2019] [Indexed: 01/28/2023]
Abstract
BACKGROUND Mineralocorticoid receptor antagonists consist of a class of drugs with pleiotropic beneficial effects in several cardiovascular diseases. However, physicians frequently overlook their use due to the adverse effects of such agents. OBJECTIVES To determine the adverse effects of mineralocorticoid receptor antagonists and to suggest clinically meaningful options. We present data on the two most administered agents of this class: spironolactone and eplerenone. METHOD We conducted an in-depth review of the existing international literature to draft a mini review about the mineralocorticoid receptor antagonists-related side effects. RESULT Mineralocorticoid receptor antagonists are associated with increased risk of hyperkalemia and acute deterioration of renal function. Of note, these adverse effects are dose-dependent, more common during the initial period of treatment, and are usually reversed after the withdrawal of therapy. Sex-related adverse events are noted mainly in spironolactone while switching to eplerenone could attenuate those. CONCLUSION Mineralocorticoid receptor antagonists therapy is significantly limited due to their side effects. The development of novel non-steroidal mineralocorticoid receptor antagonists could substantially widen the use of such agents.
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Affiliation(s)
| | - Andreas Pittaras
- Cardiology Department, Asklepieion General Hospital, Athens, Greece
| | - Iakovos Theodoulidis
- First Department of Obstetrics and Gynaecology, Aristotle University, Thessaloniki, Greece
| | - Charris Grassos
- Department of Cardiology, Hypertension Excellence Centre-ESH, KAT General Hospital, Athens, Greece
| | | | - Athanasios J Manolis
- Cardiology Department, Asklepieion General Hospital, Athens, Greece.,Cardiology Department, Emory University, Atlanta, GA, United States
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8
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Çetik S, Basaran NC, Ozisik L, Oz SG, Arici M. Gitelman Syndrome Diagnosed in a Woman in the Second Trimester of Pregnancy. Eur J Case Rep Intern Med 2019; 6:001100. [PMID: 31139589 PMCID: PMC6499100 DOI: 10.12890/2019_001100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Accepted: 03/27/2019] [Indexed: 11/05/2022] Open
Abstract
Gitelman syndrome is a rare renal tubule disease characterized by hypokalaemia, metabolic alkalosis, hypomagnesaemia, hypocalciuria and normal blood pressure. It shows autosomal recessive inheritance and is usually not diagnosed until late childhood or adulthood. We report the case of 34-year-old woman who at 21 weeks of pregnancy was admitted to the gynaecology department for abdominal pain, muscle cramps and weakness. Routine blood tests showed hypokalaemia (2.32 mEq/l), hypomagnesaemia (1.18 mEq/l), compensated metabolic alkalosis (pH 7.439, bicarbonate 26.1 mmol/l), increased urinary magnesium excretion (140.25 mg/day, normal range 73–122 mg/day) and reduced urinary calcium excretion (49.25 mg/day, normal range 100–250 mg/day). In light of these findings, the patient was diagnosed with Gitelman syndrome and optimum potassium and magnesium levels were maintained with oral supplements.
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Affiliation(s)
- Sıla Çetik
- Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Sihhiye, Ankara, Turkey
| | - Nursel Calik Basaran
- Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Sihhiye, Ankara, Turkey
| | - Lale Ozisik
- Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Sihhiye, Ankara, Turkey
| | - Serife Gul Oz
- Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Sihhiye, Ankara, Turkey
| | - Mustafa Arici
- Department of Nephrology, Faculty of Medicine, Hacettepe University, Sihhiye, Ankara, Turkey
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9
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Lack of evidence for feminization of males exposed to spironolactone in utero: A systematic review. J Am Acad Dermatol 2019; 80:1147-1148. [DOI: 10.1016/j.jaad.2018.10.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 10/06/2018] [Accepted: 10/13/2018] [Indexed: 11/23/2022]
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10
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Gitelman Syndrome: A Rare Cause of Seizure Disorder and a Systematic Review. Case Rep Med 2019; 2019:4204907. [PMID: 30867665 PMCID: PMC6379858 DOI: 10.1155/2019/4204907] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Revised: 11/20/2018] [Accepted: 01/17/2019] [Indexed: 01/06/2023] Open
Abstract
Gitelman syndrome is one of the few inherited causes of metabolic alkalosis due to salt losing tubulopathy. It is caused by tubular defects at the level of distal convoluted tubules, mimicking a thiazide-like tumor. It usually presents in late childhood or in teenage as nonspecific weakness, fatigability, polyuria, and polydipsia but very rarely with seizures. It is classically associated with hypokalemia, hypomagnesemia, hypocalciuria, hyperreninemia, and hyperaldosteronism. However, less frequently, it can present with normal magnesium levels. It is even rarer to find normomagnesemic patients of GS who develop seizures as the main complication since hypomagnesemia is considered the principal etiology of abnormal foci of seizure-related brain activity in GS cases. Interestingly, patients with GS are oftentimes diagnosed during pregnancy when the classic electrolyte pattern consistent with GS is noticed. Our case presents GS with normal serum magnesium in a patient, with seizures being the main clinical presentation. We also did a comprehensive literature review of 122 reported cases to show the prevalence of normal magnesium in GS cases and an overview of clinical and biochemical variability in GS. We suggest that further studies and in-depth analysis are required to understand the pathophysiology of seizures in GS patients with both normal and low magnesium levels.
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11
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Elbouajaji K, Blanchier D, Pourrat O, Sarreau M. [Management of Gitelman syndrome during pregnancy reporting 12 cases]. Nephrol Ther 2018; 14:536-543. [PMID: 30309814 DOI: 10.1016/j.nephro.2018.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 06/08/2018] [Accepted: 06/24/2018] [Indexed: 02/09/2023]
Abstract
INTRODUCTION Gitelman syndrome is a rare hereditary renal tubulopathy, responsable of hypokalemia and hypomagnesaemia-related ionic disorders, which management is poorly codified during pregnancy. We report 12 cases of pregnancies with Gitelman syndrome and we compare our data with those of literature. MATERIAL AND METHODS It is a report of 12 pregnancies in 5 patients with Gitelman syndrome between 2002 and 2016. Follow up and outcome of pregnancy, delivery modalities and maternal-fetal prognosis have been collected. RESULTS In our serie, maximum kaliemie observed was 3.4mmol/L, with an average potassium, over all pregnancies of 2.3mmol/L. Oral potassium and magnesium supplementation at the end of pregnancy were 8900mg/day and 460mg/day, respectively. There were no serious maternal complications. Two pregnancies were complicated by intrauterine growth retardation in a context of preeclampsia. There is a large disparity in the methods of anesthetic management of these patients. Materno-fetal prognosis at 1 month post-partum is good. CONCLUSION Gitelman syndrome is a rare pathology where there is a lack of homogeneity in management of pregnancy. Monitoring of monthly ionogram is necessary. The goal is to obtain stable, non-symptomatic kaliemias, which will never be standardized even in increasing treatment. The most important is to inform and detect situations at risk of decompensation, including vomiting or the use of certain anesthetics. In agreement with literature data, monitoring of fetal growth and the amount of amniotic fluid in the third trimester is still warranted. These pregnancies require the development of a common care in multidisciplinary consultation meeting.
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Affiliation(s)
- Karima Elbouajaji
- Service de gynécologie obstétrique et médecine de la reproduction, CHU de Poitiers, 2, rue de la Milétrie, 86000 Poitiers, France
| | - Dominique Blanchier
- Service de néphrologie, CH d'Angoulême, Rond-point de Girac, 16000 Angoulême, France
| | - Olivier Pourrat
- Service de réanimation médicale, CHU de Poitiers, 2, rue de la Milétrie, 86000 Poitiers, France
| | - Mélie Sarreau
- Service de gynécologie obstétrique, CH d'Angoulême, Rond-point de Girac, 16000 Angoulême, France.
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Abstract
Hereditary kidney disease comprises approximately 10% of adults and nearly all children who require renal replacement therapy. Technologic advances have improved our ability to perform genetic diagnosis and enhanced our understanding of renal and syndromic diseases. In this article, we review the genetics of renal diseases, including common monogenic diseases such as polycystic kidney disease, Alport syndrome, and Fabry disease, as well as complex disorders such as congenital anomalies of the kidney and urinary tract. We provide the nephrologist with a general strategy to approach hereditary disorders, which includes a discussion of commonly used genetic tests, a guide to genetic counseling, and reproductive options such as prenatal diagnosis or pre-implantation genetic diagnosis for at-risk couples. Finally, we review pregnancy outcomes in certain renal diseases.
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Affiliation(s)
- Lakshmi Mehta
- Division of Medical Genetics, Department of Genetics and Genomic Sciences/Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Belinda Jim
- Division of Nephrology, Department of Medicine, Albert Einstein College of Medicine, Jacobi Medical Center, Bronx, NY
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13
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Two cases of successful pregnancy in patients with Gitelman's syndrome. Clin Nephrol 2018; 84:301-6. [PMID: 26109196 PMCID: PMC4776256 DOI: 10.5414/cn108526] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2015] [Indexed: 12/28/2022] Open
Abstract
Gitelman's syndrome (GS) is a distal convoluted tubule (DCT) defect clinically characterized by hypokalemic metabolic alkalosis. Pregnancy in women with GS often results in severe hypomagnesemia and hypokalemia. We report two cases of successful pregnancies, after previous fetal loss, in patients with GS managed with aggressive oral and intravenous electrolyte repletion. These cases illustrate increased potassium and magnesium requirements over the course of the pregnancies and are notable due to the high doses of electrolytes required. They also demonstrate the possibility of successful pregnancy outcomes with frequent laboratory monitoring and aggressive titration of electrolyte replacement either orally or intravenously to maintain appropriate serum levels necessary to provide a suitable environment for fetal development.
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14
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Elkoundi A, Kartite N, Bensghir M, Doghmi N, Lalaoui SJ. Gitelman syndrome: a rare life-threatening case of hypokalemic paralysis mimicking Guillain-Barré syndrome during pregnancy and review of the literature. Clin Case Rep 2017; 5:1597-1603. [PMID: 29026553 PMCID: PMC5628240 DOI: 10.1002/ccr3.1122] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 04/26/2017] [Accepted: 07/20/2017] [Indexed: 11/29/2022] Open
Abstract
In rare cases, patients with Gitelman syndrome may present with hypokalemic paralysis mimicking Guillain–Barré syndrome. The severity of resultant symptoms may be life‐threatening. Controversial drugs such as aldactone, amiloride, and eplerenone should be used in this situation despite the lack of safety data.
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Affiliation(s)
- Abdelghafour Elkoundi
- Department of Anesthesiology and Intensive Care Military Hospital Mohammed V Faculty of Medicine and Pharmacy of Rabat Mohammed V University Rabat Morocco
| | - Noureddine Kartite
- Department of Anesthesiology and Intensive Care Military Hospital Mohammed V Faculty of Medicine and Pharmacy of Rabat Mohammed V University Rabat Morocco
| | - Mustapha Bensghir
- Department of Anesthesiology and Intensive Care Military Hospital Mohammed V Faculty of Medicine and Pharmacy of Rabat Mohammed V University Rabat Morocco
| | - Nawfal Doghmi
- Department of Anesthesiology and Intensive Care Military Hospital Mohammed V Faculty of Medicine and Pharmacy of Rabat Mohammed V University Rabat Morocco
| | - Salim Jaafar Lalaoui
- Department of Anesthesiology and Intensive Care Military Hospital Mohammed V Faculty of Medicine and Pharmacy of Rabat Mohammed V University Rabat Morocco
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15
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Lee M, Kim DI, Lee KH, Byun JH, Hwang J, Hwang WM, Yun SR, Yoon SH. HELLP syndrome in a pregnant patient with Gitelman syndrome. Kidney Res Clin Pract 2017; 36:95-99. [PMID: 28393002 PMCID: PMC5331980 DOI: 10.23876/j.krcp.2017.36.1.95] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 07/19/2016] [Accepted: 07/25/2016] [Indexed: 11/04/2022] Open
Abstract
Gitelman syndrome is characterized by hypokalemia, metabolic alkalosis, hypocalciuria, and hypomagnesemia. The clinical course of Gitelman syndrome in pregnant women remains unclear, but it is thought to be benign. We report here the first Korean case of atypical eclampsia in a 31-year-old who was diagnosed with Gitelman syndrome incidentally during an antenatal screening test. The patient did well during pregnancy despite significant hypokalemia. At 33 weeks' gestation, the patient exhibited eclampsia, hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome, and renal insufficiency without significant hypertension or proteinuria. We explain this unusual clinical course through a review of the relevant literature.
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Affiliation(s)
- Minhyeok Lee
- Department of Internal Medicine, Konyang University College of Medicine, Daejeon, Korea
| | - Dong-Il Kim
- Department of Internal Medicine, Konyang University College of Medicine, Daejeon, Korea
| | - Kyung-Ho Lee
- Department of Internal Medicine, Konyang University College of Medicine, Daejeon, Korea
| | - Jun-Hyun Byun
- Department of Internal Medicine, Konyang University College of Medicine, Daejeon, Korea
| | - Jiyong Hwang
- Department of Internal Medicine, Konyang University College of Medicine, Daejeon, Korea
| | - Won-Min Hwang
- Department of Internal Medicine, Konyang University College of Medicine, Daejeon, Korea
| | - Sung-Ro Yun
- Department of Internal Medicine, Konyang University College of Medicine, Daejeon, Korea
| | - Se-Hee Yoon
- Department of Internal Medicine, Konyang University College of Medicine, Daejeon, Korea
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16
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Merhi B, Miller M, Lanis A, Katz B, Hsu T, Tong I. Management of uncommon disorders in pregnancy: Von Hippel-Lindau disease, Gitelman syndrome, and Nutcracker syndrome. Obstet Med 2016; 10:138-141. [PMID: 29051782 DOI: 10.1177/1753495x16683088] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 11/09/2016] [Indexed: 01/10/2023] Open
Abstract
Uncommon renal disorders in pregnancy can be challenging to manage given limited evidence in the literature to guide management. We present a series of three uncommon renal disorders in pregnancy: Von Hippel-Lindau disease, Gitelman syndrome, and Nutcracker syndrome. Previously published case reports with differing outcomes offer some guidance to the management of these disorders in pregnancy. In this case series, we address the management of these syndromes during pregnancy and discuss the maternal and fetal outcomes. All three of our patients had good maternal and fetal outcomes, which will contribute to current data on maternal and fetal outcomes in these rare diseases, which is limited.
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Affiliation(s)
- Basma Merhi
- Division of Nephrology, Department of Medicine, Alpert Medical School of Brown University, Providence, USA
| | - Margaret Miller
- Division of Obstetric Medicine, Department of Medicine, Alpert Medical School of Brown University, Providence, USA
| | - Aviya Lanis
- Internal Medicine Residency Program, Santa Clara Valley Medical Centre, California, USA
| | - Brittany Katz
- Internal Medicine Residency Program, Santa Clara Valley Medical Centre, California, USA
| | - Tiffany Hsu
- Internal Medicine Residency Program, Santa Clara Valley Medical Centre, California, USA
| | - Iris Tong
- Division of General Internal Medicine, Department of Medicine, Alpert Medical School of Brown University, Providence, USA
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Hyperemesis Gravidarum in Undiagnosed Gitelman's Syndrome. Case Rep Med 2016; 2016:2407607. [PMID: 27579038 PMCID: PMC4992520 DOI: 10.1155/2016/2407607] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 07/05/2016] [Indexed: 11/18/2022] Open
Abstract
Introduction. Gitelman's syndrome (GS) is an autosomal recessive inherited defect in the thiazide-sensitive sodium-chloride cotransporter (NCCT) in the renal distal convoluted tubule. Physiologic changes of pregnancy promote renal potassium wasting, but serum potassium levels are kept in the physiologic range by increased levels of progesterone, which resist kaliuresis. In the presence of GS, this compensatory mechanism is easily overwhelmed, resulting in profound hypokalemia. We present a case of an 18-year-old primigravida with undiagnosed GS who presented with hyperemesis gravidarum in her 7th week of pregnancy. This report adds to the limited experience with GS in pregnancy as reported in literature and provides additional information on medical management that leads to successful maternal and fetal outcomes.
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Landau E, Amar L. Primary aldosteronism and pregnancy. ANNALES D'ENDOCRINOLOGIE 2016; 77:148-60. [PMID: 27156905 DOI: 10.1016/j.ando.2016.04.009] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Accepted: 04/11/2016] [Indexed: 11/30/2022]
Abstract
Hypertension (HT) is a complication of 8% of all pregnancies and 10% of HT cases are due to primary aldosteronism (PA). There is very little data on PA and pregnancy. Given the changes in the renin angiotensin system during pregnancy, the diagnosis of PA is difficult to establish during gestation. It may be suspected in hypertensive patients with hypokalemia. A comprehensive literature review identified reports covering 40 pregnancies in patients suffering from PA. Analysis of these cases shows them to be high-risk pregnancies leading to maternal and fetal complications. Pregnancy must be programmed, and if the patient has a unilateral form of PA, adrenalectomy should be performed prior to conception. It is customary to stop spironolactone prior to conception and introduce antihypertensive drugs that present no risk of teratogenicity. When conventional antihypertensive drugs used during pregnancy fail to control high blood pressure, diuretics, including potassium-sparing diuretics may be prescribed. Adrenalectomy can be considered during the second trimester of pregnancy exclusively in cases of refractory hypertension. A European retrospective study is currently underway to collect a larger number of cases.
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Affiliation(s)
- Ester Landau
- Université Paris-Descartes Faculty of Medicine, 75006 Paris, France
| | - Laurence Amar
- Hypertension Unit, Assistance Publique-Hôpitaux de Paris, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France.
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Riester A, Reincke M. Progress in primary aldosteronism: mineralocorticoid receptor antagonists and management of primary aldosteronism in pregnancy. Eur J Endocrinol 2015; 172:R23-30. [PMID: 25163723 DOI: 10.1530/eje-14-0444] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Primary aldosteronism (PA) is the most common cause of secondary hypertension. In this review, we discuss the diagnosis and management of PA during pregnancy based on the literature. As aldosterone and renin are physiologically increased during pregnancy and confirmation tests are not recommended, the diagnosis of PA during pregnancy relies on a repeatedly suppressed plasma renin level. Mineralocorticoid receptor antagonists (MRAs) are the most effective drugs to treat hypertension and hypokalemia in patients with PA. However, spironolactone (FDA pregnancy category C) might lead to undervirilization of male infants due to the anti-androgenic effects. Although data in the literature are very limited, treatment with spironolactone is not recommended. Eplerenone (FDA pregnancy category B) is a selective MRA without anti-androgenic potential. If MRA treatment is required in pregnancy, eplerenone appears to be a safe and effective alternative, although symptomatic treatment with approved antihypertensive drugs and supplementation with potassium is the first choice. In case of aldosterone-producing adenoma, laparoscopic adrenalectomy is a therapeutic option in the second trimester of pregnancy.
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Affiliation(s)
- Anna Riester
- Medizinische Klinik und Poliklinik IVKlinikum der Ludwig-Maximilians-Universität München, Ziemssenstraße 1, 80336 Munich, Germany
| | - Martin Reincke
- Medizinische Klinik und Poliklinik IVKlinikum der Ludwig-Maximilians-Universität München, Ziemssenstraße 1, 80336 Munich, Germany
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Shinar S, Gal-Oz A, Weinstein T, Levin I, Maslovitz S. Gitelman syndrome during pregnancy – from diagnosis to treatment: a case series and review of the literature. CASE REPORTS IN PERINATAL MEDICINE 2014. [DOI: 10.1515/crpm-2013-0043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Objective: Gitelman syndrome (GS) is a rare renal disease, originating from a defect in the Na-Cl co-transporter in the distal tubule, which causes hypokalemia, hypomagnesemia, hypocalciuria, metabolic alkalosis and low-normal blood pressure. Mild hypokalemia of pregnancy is physiological. Fatigue, nausea, vomiting, polyuria and low blood pressures are also common complaints associated with a normal pregnancy. Therefore, the diagnosis of an organic renal disorder, i.e., GS, may go undetected, until severe hypokalemia and possible life-threatening cardiac arrhythmias develop. Maternal consequences are obvious. The possibility of fetal pathology remains unclear.
Study design: In this study, we describe nine pregnancies in seven women with a clinical diagnosis of GS. Nearly all women were diagnosed initially during pregnancy. We describe their clinical presentation, serum and urine electrolyte levels during pregnancy and immediately post-partum, their treatment and pregnancy outcome.
Results: Fetal pregnancy outcomes were mostly favorable. While it is likely that women suffering from GS do not require special fetal surveillance, they are at high risk for electrolyte depletion and thus aggravation of GS during pregnancy.
Conclusion: Clinical suspicion of GS should arise in all women presenting with symptomatic hypokalemia. Once the diagnosis is made, adequate supplementation and routine maternal monitoring should ensue.
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Affiliation(s)
| | - Amir Gal-Oz
- Department of Nephrology, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Talia Weinstein
- Department of Nephrology, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Ishai Levin
- Department of Gynecology, Lis Maternity Hospital, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Sharon Maslovitz
- Department of Gynecology, Lis Maternity Hospital, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
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Morton A. Reply to: Timothy A C Snow, Cara A Wasywich and Fiona M Stewart. A case of breathlessness during pregnancy: the difficulty in diagnosing heart failure Obstet Med OM.2012.120031; published ahead of print 20 December 2012, doi:10.1258/OM.2012.120031. Obstet Med 2013; 6:94. [DOI: 10.1177/1753495x13479116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Adam Morton
- Mater Hospital, Raymond Tce, South Brisbane 4101, Australia
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Mathen S, Venning M, Gillham J. Outpatient management of Gitelman's syndrome in pregnancy. BMJ Case Rep 2013; 2013:bcr-2012-007927. [PMID: 23355577 DOI: 10.1136/bcr-2012-007927] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Gitelman's syndrome is a congenital renal tubular defect which affects the apical membrane of the distal convoluted tubule of the renal system. The syndrome is characterised by hypokalaemia, hypomagnesaemia, metabolic alkalosis and hypocalcuria. There are only a few cases describing the impact of Gitelman's syndrome on pregnancy and the foetus. Although most pregnancies have favourable outcomes, fetal demise has been reported in the third trimester. We report the successful outcome of pregnancy in a patient with Gitelman's syndrome who continued on amiloride in pregnancy to optimise potassium and magnesium levels and review the literature for pregnancy outcomes of this condition.
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Affiliation(s)
- Stephy Mathen
- Department of Obstetrics and Gynaecology, Mid Cheshire Hospitals NHS Foundation Trust, Crewe, UK.
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Moustakakis MN, Bockorny M. Gitelman syndrome and pregnancy. Clin Kidney J 2012; 5:552-5. [PMID: 26064481 PMCID: PMC4400552 DOI: 10.1093/ckj/sfs126] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2012] [Accepted: 08/09/2012] [Indexed: 11/14/2022] Open
Abstract
Gitelman syndrome (GS) is an autosomal-recessive condition characterized by hypokalemia, hypomagnesemia and hypocalciuria. Very little information is available in the literature to guide the management of pregnant patients with GS. We report a case of a 27-year-old woman with GS who became pregnant and despite persistent hypokalemia and hypomagnesemia during pregnancy and labor, had a successful maternal and fetal outcome.
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Calò LA, Caielli P. Gitelman’s syndrome and pregnancy: new potential pathophysiological influencing factors, therapeutic approach and materno-fetal outcome. J Matern Fetal Neonatal Med 2011; 25:1511-3. [DOI: 10.3109/14767058.2011.629254] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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25
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Raffi F, Fairlie FM, Madhuvrata P, Bennet WM. Pregnancy with Gitelman's syndrome. Obstet Med 2011; 4:39-41. [PMID: 27579097 DOI: 10.1258/om.2010.100046] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2010] [Indexed: 11/18/2022] Open
Abstract
Gitelman's syndrome is a rare genetic disease associated with chronic hypokalaemia, hypomagnesaemia and hypocalciuria. It requires lifelong supplementation with potassium and magnesium. Pregnancy management can be difficult and there are few published reports. Our case adds to the literature and illustrates some of the potential problems.
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Affiliation(s)
- F Raffi
- Jessop Wing - Obstetrics and Gynaecology , Sheffield , UK
| | - F M Fairlie
- Jessop Wing - Obstetrics and Gynaecology , Sheffield , UK
| | - P Madhuvrata
- Jessop Wing - Obstetrics and Gynaecology , Sheffield , UK
| | - W M Bennet
- Jessop Wing - Obstetrics and Gynaecology , Sheffield , UK
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Shanbhag S, Neil J, Howell C. Anaesthesia for caesarean section in a patient with Gitelman’s syndrome. Int J Obstet Anesth 2010; 19:451-3. [DOI: 10.1016/j.ijoa.2010.05.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2009] [Revised: 09/01/2009] [Accepted: 05/11/2010] [Indexed: 10/19/2022]
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LAKHI N, JONES J, GOVIND A. Fetal demise despite normalisation of serum potassium in Gitelman syndrome
Case report and literature review. Aust N Z J Obstet Gynaecol 2010; 50:301-2. [DOI: 10.1111/j.1479-828x.2010.01156.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Daskalakis G, Marinopoulos S, Mousiolis A, Mesogitis S, Papantoniou N, Antsaklis A. Gitelman syndrome-associated severe hypokalemia and hypomagnesemia: case report and review of the literature. J Matern Fetal Neonatal Med 2010; 23:1301-4. [DOI: 10.3109/14767051003678010] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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